■在前交叉韧带(ACL)手术期间,伴随损伤的手术率越来越高。很少有研究检查年轻患者中这些相关损伤的危险因素。
■有与患者相关的因素预测伴随的膝关节病理在基于年龄的队列中不同。
■横断面研究;证据水平,3.
■自然语言处理用于从2000年至2020年在单一机构接受ACL手术的患者的可用笔记中提取临床变量(5174ACL手术;平均年龄,17±4岁;53.1%女性;准确性,>98%)。患者被分层为儿科(5-13年),青少年(14-19岁),和年轻的成年人(20-35岁)队列。Logistic回归用于确定伴随半月板损伤的预测因子,内侧副韧带(MCL),后外侧角(PLC),和后交叉韧带(PCL)。
■从2000年到2020年,54%的儿科,71%的青少年,70%的成年患者合并有≥1次软组织损伤。在儿童和青少年中,年龄增长始终预示着伴随损伤(P<.02)。女性儿童伴随内侧半月板损伤的几率增加,而女性成年人的几率降低(P≤.046)。青少年和成年女性患者同时发生外侧半月板损伤的几率降低(P≤.027)。女性儿童MCL受伤的几率增加(P=0.015),而女性儿童和青少年PCL损伤的几率降低(P≤.044).接受ACL翻修术的青少年半月板损伤的几率增加(P≤0.001),同时MCL损伤的几率降低(P=0.028)。在所有队列中,体重指数(BMI)增加与伴随内侧半月板损伤的几率增加相关(P≤0.041),成人外侧半月板损伤(P=.045),儿童PLC损伤(P=0.016)。接触损伤与青少年MCL损伤(P=0.017)和青少年和成人PLC损伤(P<.014)的几率增加相关。
■这些发现支持了这一假设,因为有多种因素显著影响伴随损伤的风险,不同队列之间存在差异.年龄增加,BMI,接触损伤史通常与伴随损伤的几率增加有关,而女性和修正ACL手术具有混合效果。进一步的研究对于调查伴随损伤风险的性别差异以及制定量身定制的治疗计划以最大程度地减少继发性ACL损伤的风险至关重要。
There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients.
There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts.
Cross-sectional study; Level of evidence, 3.
Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL).
Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014).
These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.